Don't Shoot the Messenger!
If you blame Obamacare for the awful defects in our healthcare system, you are indeed naïve, since any cost-effectiveness or fairness in our system disintegrated long before Barack Obama, or even George W, came to office. I am not a partisan person. I have voted as often for a Republican candidate as for a Democratic one, although I also realize the likes of Sarah Palin are a rancid infection in the Republican party. Given the current character of our healthcare system, I would not advise most, unless they enter school with a real understanding of their bleak future, to enter the field of medicine.
Healthcare has been taken over by the greediest of narcissists, concerned only with their craving for power and income. The wealthiest of physicians now are more often those who steal or cheat and have the weakest credentials. Want to be a rich cardiologist? Perform as many unnecessary stent procedures as possible. Wish to make millions as an orthopedist? Give up taking care of patients who need good care and sell yourself to law firms and become a workman’s comp doctor. Want to drive a Lamborghini? Then betray your Hippocratic Oath and perform tests that you were never trained to do and your patients don’t need. If you consider who became rich and powerful during the days of prohibition, you will understand that the rich and powerful in the field of medicine are similar minds.
It isn’t very difficult to become a physician; just about anyone, with enough money, can get into some quasi accredited foreign medical school and make their way back to the States. Others, both the best and the worst, leave their countries bound for America, some becoming top doctors while others make their way here resorting to theft and harming the innocent. It is something that hitherto few would say publicly, but it is obvious to most who practice today. For those who are smart and worked hard to get into a competitive medical school, they are afforded the same MD as the person who finished at the bottom of their class at a school on some Caribbean Island.
Physicians are not rewarded for a good history and exam. Payments, dictated by Medicare and other insurers, are paltry compared to imaging studies and procedures. For example: A duplicitous physician who wishes to become rich, regardless of his credentials or knowledge, can easily start imaging all his patients with sonograms, echocardiograms, and other imaging studies. This has become such a common scheme to defraud insurers that I am now seeing patients, who come to see me (they are never sent to me by these doctors, since I am not in their criminal loop) wanting to know what is wrong with their heart. The answer I usually give them is, nothing!
What do I and the other honest cardiologists get for not being part of these schemes? We get the most important thing, the feeling that we have not stepped over to the dark side, the realization that we are doctors and not criminals. But we also get punished by not being part of some network, we lose patients, and we also get punished by the payers, who instead of criminalizing what these doctors do, accept their behavior as everyday business, and cut their expenses by reducing their payments to every single doctor, good or bad, honest or dishonest.
Twenty years ago, before the marriage of portable echo companies with deceitful doctors; before every patient who walked into the office of Dr. X (a family physician who somehow hears a murmur on every healthy patient), was sent for an echocardiogram, many insurers paid about $600 dollars for this study. Today, to keep the burden of echo costs down, most insurers pay about $285 dollars. In a metropolitan area, like New York City, where there are imaging centers and cardiologists often within walking distance from a primary care doctor, you have to wonder why any insurer would allow portable imaging to be paid for at a doctor’s office. Stop this policy and BILLIONS of dollars of illegal billing will be saved.
While young and honest physicians, who are well trained and hope to be real caregivers, struggle on miniscule salaries to pay back their half-million dollars in student loans, administrators of non-profit hospitals are afforded limousines and multi-million dollar salaries.
Big Pharma continues to bribe doctors to prescribe drugs that are much more costly, but often no more effective than a similar drug, not with free pens, that our FDA has forbidden, but by paying doctors to lecture for them. The Sunshine Act will mandate that Pharma publish the amounts paid to these doctors, but I suspect it will have limited shame-on-you impact. And possibly because the same physicians who helped write this act will benefit from this clause, the Sunshine Act will not include any payments to doctors, even if they are paid by big Pharma, if their lecture is part of a continuing medical education (CME) meeting. I interpret this as a smooth maneuver by some top physicians who want to get paid big bucks from big Pharma and slip under the radar of the Sunshine Act.
The affordable care act will cost us over one trillion dollars over the next decade. I agree that our healthcare system is unfair, for patients, the uninsured, and honest physicians, but I don’t agree with the lack of some very simple remedies that ACA lacks and that can help fund healthcare and improve it as well. There are countless billions of dollars in waste in the system and even more in fraudulent charges. Why not have a healthcare system that rewards physicians that practice good and honest medicine? Why not criminalize and punish doctors and hospital administrators that cheat the system? Why not put a cap on salaries at our non-profit institutions, or at least tax non-profits that are so awash in cash that they can pay a five-million dollar salary to their CEO? Is it appropriate for a local community not-for-profit hospital to continue to increase the salaries of administrators, some of whom make well in excess of a million dollars, and then cut nursing jobs and other ancillary services? Shouldn’t there be more accountability of non-profit hospitals?
If we look at the economics of our healthcare system as a leaking fish tank, it appears to me that we are just pouring more water into something that will spring even larger leaks. I think we need to fix those cracks!
About the author: Evan S. Levine, MD FACC, is Director of the Cardiovascular Center at Saint Joseph’s Hospital and a Clinical Assistant Professor of Medicine at Montefiore Medical Center – Albert Einstein College of Medicine. He is also the author of the book “What Your Doctor Won’t (or can’t) Tell You”. He lives in Connecticut with his wife and children.